Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Case Series

Abstract

BACKGROUND: Chronic subdural hematoma (CSDH) represents a common neurosurgical condition particularly in the elderly. Middle meningeal artery embolization (MMAE) has been proposed as a treatment option for this condition. OBJECT: To demonstrate the feasibility of MMAE for the treatment of CSDH avoiding the risk of interrupting anticoagulation and reducing the perioperative risk in a Canadian health care institution. METHODS: A retrospective chart review of patients receiving MMAE as primary treatment for CSDH is presented. Baseline demographics are collected (age, sex, and side of hematoma). Outcomes of interest include hematoma thickness pre-intervention and at follow up, procedural and post-operative complications, and length of hospital stay. Clinical outcomes (subdural hematoma resolution) are supplemented by computed tomography (CT) imaging. RESULTS: Patients (N=4) underwent MMAE for the treatment of CSDH to avoid risk of cessation of anticoagulation and expected perioperative risk. Median age was 74 years. Two patients were on antithrombotic therapy at the time of intervention. Patient follow-up occurred at 1, 3, 6, and 9 months post-operatively. Resolution of symptoms and significant reduction of hematoma thickness was evident (up to 14 mm) at follow-up. Improvement in all cases was confirmed by CT and clinical evaluation. No patients suffered from complications or recurrence. CONCLUSION: The MMAE is a safe and practical treatment for CSDH, even in this rather frail patient cohort with some on anticoagulation.